- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,418.40 / $13,418.40 / $13,418.40
| Facility | | $13,418.40 | $13,418.40 | $13,418.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,314.07 / $10,677.66 / $10,677.66
| Facility | | $10,314.07 | $10,677.66 | $10,677.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,298.38 / $8,874.99 / $15,694.68
| Facility | | $6,298.38 | $8,874.99 | $15,694.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $950.00 / $950.00
| Facility | | $950.00 | $950.00 | $950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,978.80 / $9,977.20 / $16,329.98
| Facility | | $6,978.80 | $9,977.20 | $16,329.98 |